People with HIV should start treatment earlier than previously recommended, according to World Health Organization guidelines that may prevent 3 million deaths and boost sales for drugmakers including Cipla Ltd. (CIPLA)
Commencing treatment at an earlier stage of infection would expand the number of people eligible for therapy to 26 million from 17 million and prevent about 3.5 million infections by 2025, the Geneva-based WHO said today in the first update to its treatment guidelines since 2010.
The new recommendations come amid research that shows earlier treatment helps patients and limits transmission. Increasing the number of people treated will add about 10 percent to the $24 billion that's needed annually to fight the epidemic now, the WHO said. That may boost sales for Mumbai, India-based Cipla and Johannesburg-based Aspen Pharmacare Holdings Ltd. (APN), which make generics of AIDS drugs for developing nations.
The new guidelines can help “bring the epidemic to an irreversible decline,” Meg Doherty, the coordinator of treatment and care in the WHO’s HIV/AIDS department, told reporters at a briefing in Geneva.
About 34 million people were infected with HIV at the end of 2011, making it the world’s most prevalent infectious disease, according to the Joint United Nations Programme on HIV/AIDS, or UNAIDS. The virus killed an estimated 1.7 million people that year.
Still, the number of new infections has declined each year since peaking in 1997 as treatment was expanded, according to UNAIDS. About 9.7 million people were on drugs at the end of last year, and 1.6 million people started treatment, the biggest increase in a single year, as funding in developing nations to fight local epidemics exceeded international donations for the first time.
The new guidelines advise that adults and adolescents start treatment when their number of CD4 cells -- the infection-fighting cells that HIV attacks -- drops below 500 per cubic millimeter of blood. The WHO previously recommended starting treatment at 350 cells per cubic millimeter, to avoid the side effects, inconvenience and costs associated with drugs that must be taken every day for the rest of an infected person’s life. Healthy people have a CD4 count of between 800 and 1,200.
The U.S. recommends people start treatment as soon as they are diagnosed, regardless of their CD4 count. The evidence isn’t sufficient to support that policy at a global level, Doherty said, though the WHO is recommending treatment regardless of CD4 count for children under 5 years, pregnant and breastfeeding women, and people who have an uninfected partner.
In a trial among 1,763 couples where only one partner was infected, those who started treatment immediately were 96 percent less likely to transmit HIV to their partner than those who started therapy later.
Aspen, Mylan Inc. (MYL) of Canonsburg, Pennsylvania, and Cipla Medpro South Africa Ltd. won the biggest shares of a South African government contract in November to supply AIDS drugs worth 5.9 billion rand ($586 million) over two years. Gilead Sciences Inc. (GILD) of Foster City, California, is the biggest seller of HIV drugs in wealthy countries.
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